Revenue Cycle Representative Senior - Business Office

Description Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: Responsible for performing a variety of complex duties in support of reimbursement from patient and insurance carriers throughout the revenue cycle from pre-service with prior authorizations and insurance verification to post-service with billing, follow-up and collections. Requires substantial knowledge of all carrier policies, procedures and practices necessary to collect carrier accounts receivable and resolve denials. Participates and assists in special projects. Assists new or existing staff with training or techniques to increase production and quality as well as provide support for the team members that may be absent or backlogged. Perform all duties in a manner which promotes teamwork and reflects UNC Health Care's mission and philosophy. Responsibilities Appeals & Managed Care Escalations: Project manage all 3rd‑party appeals including researching and determining if carrier denial of a claim is valid and, if not, abstracting information from medical records to support the appeal of denial. Work in conjunction with resources such as Coding, HIM or clinicians to ensure that the appeal is effective and perform charge corrections/coding changes in accordance with all (internal and external) regulatory and coding guidelines/policies. Facilitate monthly provider calls and managed care escalations. Training & Backup: Support management in onboarding new hires and provide technical support to existing staff to ensure minimal time to productivity and optimal quality. Be available to step in to alleviate any operational impacts associated with turnover or other staffing‑related issues. Patient & Provider Follow‑up: Review, resolve and, if necessary, elevate to management patient‑level issues stemming from contested charges, risk management or patient relations. Cosmetic & Elective Account Agreements: Review agreements to ensure accurate postings and processing by carriers. Troubleshoot self‑pay payment issues including credit‑card charge‑back notices and NSF checks. Credit Management: Perform complex remit processing (PLB's, FB's, WO's) and serve as back‑up to input deposits into cash databases. Review and process insurance credits to resolve credit balances through refunds or posting adjustments. Compile Medicare/Medicaid cash reports and quarterly credit balance reports. Payor Audits & Pro‑Active Medical Records Requests: Oversee and document all submissions pertaining to payor‑generated pre‑payment audits and/or medical records requests. AR Reduction & Quality Review Projects: Identify and project manage higher‑level AR reduction projects. Assist management with quality audits, including reviewing and approving adjustment requests at their approved level. Analysis: Use available reporting tools to analyze, trend/quantify and, if necessary, elevate to appropriate stakeholders to drive improvements in preventing denials or resolving aging accounts. Research & Transplant: Perform charge reviews, follow‑up and payment allocations for HB & PB transplant services. Review and correct billing issues with research accounts to ensure proper billing. Other: Process Part B split claims. Accurately and thoroughly document the pertinent collection or follow‑up activity performed. Meet or exceed productivity and quality standards. Escalate issues to senior team members and/or management that impact successful account resolution. Other Information Education Requirements: High school diploma or GED. Licensure/Certification Requirements: No licensure or certification required. Professional Experience Requirements Three (3) years of experience in hospital or physician insurance related activities (authorization, billing, follow‑up, call‑center, or collections). Knowledge/Skills/Abilities Requirements Excellent written and verbal communication skills. Intermediate technical skills including PC and MS Outlook. Advanced knowledge of explanation of benefits (EOB) and either or both the UB‑04 for hospital billing or the HCFA 1500 for professional billing. Intermediate knowledge of CPT and ICD‑10 codes. Advanced knowledge of insurance billing, collections and insurance terminology. Extensive knowledge of 3rd‑party reimbursements from insurance companies and government payers is a plus. Job Details Legal Employer: NCHEALTH Entity: Johnston Health Organization Unit: Business Office Work Type: Full Time Standard Hours Per Week: 40.00 Salary Range: $19.78 - $28.12 per hour (Hiring Range) Pay offers are determined by experience and internal equity Work Assignment Type: Hybrid Work Schedule: Day Job Location of Job: US:NC:Smithfield Exempt From Overtime: Exempt: No Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. Please email View email address on click.appcast.io if you need a reasonable accommodation to search and/or to apply for a career opportunity. #J-18808-Ljbffr UNC Health Care